Job Description

Job Title: Quality Assurance Coding Specialist
Job ID: 735929
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility: UPMC Health Plan
Department: MEDICARE HCC
Location: 600 Grant St, Pittsburgh PA 15219

Description

Purpose:

At UPMC, we rely on our over 80,000 employees to enrich the lives of the community around us. Every member of our team is a vital factor in innovating the health care industry. Every employee is responsible for creating a motivating, rewarding culture. We have a vision for every person at UPMC, and we’re looking to hire a Quality Assurance Coding Specialist to join us in creating life changing medicine.

The Coding Specialist is responsible for quality review/monitoring of Health Plan Coding Specialist Staff or external coding personnel.  This role performs auditing functions including monitoring, coding of diagnosis, reviewing medical record documentation and discharge summaries to determine if appropriate code was assigned to ensure Health Plan compliance with coding standards. The Coding Specialist provides coding related support to internal Quality Assurance/Fraud and Abuse staff.

This role is a Monday through Friday during daylight hours at the US Steel Tower.  Apply today if this sounds like a fit for you!

Responsibilities:
  • Communicate effectively with Risk Adjustment Staff, nurse reviewers and physicians and ancillary departments as necessary to address issues and concerns.
  • Compile and report statistical data to internal and external customers.
  • Completion of special projects including claims and/or coding related audit support.
  • Determine diagnoses that were treated, monitored and evaluated and procedures done during the episode of care to validate that the appropriate codes were assigned by the HCC Coding Specialist.
  • Ensure that all codes are documented for the assignment of a valid and accurate Hierarchical Condition Category (HCC).
  • Monitor the assignment of the principal and secondary diagnoses and procedures by thoroughly reviewing all documentation in the medical record utilizing knowledge of anatomy, physiology, medical terminology and pathology.
  • Provide assistance to other departments as requested.
  • Review the coding of diagnoses and verifying the proper ICD-10-CM codes were assigned by the HCC Coding Specialist.
  • Review the discharge summary, history and physical, physician progress notes, consultation reports, radiology, laboratory, pathology, operative records, emergency room record to accurately assign a diagnosis and / or procedure.
  • Utilize standard coding guidelines and principles and coding clinics to verify that the appropriate ICD-10-CM and CPT codes were assigned including modifiers for correct DRG/APC assignment and accurate reimbursement.

Qualifications

  • Graduate of an approved Health Record Administration or Accredited Medical Record Technician program (RHIA/RHIT or eligible) or a certified coding program. 
  • Five years of coding experience in a health care setting. 
  • Extensive knowledge of ICD-10 and CPT classifications and coding of diagnoses and procedures is required. 
  • In depth knowledge of medical terminology, human anatomy/physiology, pharmacology, and pathology is required. 
  • The ability to problem solve and to communicate in a professional manner with staff and other health care professionals is essential. 
  • Excellent written and verbal communication skills are essential. 
  • Proficiency in computer skills required for coding (MARS, Cerner). 
  • Detail oriented individual with excellent organizational skills.  
  • High degree of oral and written communication skills.  
  • Proficiency in MS Office/PC skills. 
  • Traveling may be required as necessary. 
  • EDUCATIONAL/KNOWLEDGE PREFERENCES: Bachelors Degree or equivalent education/experience.  Three years of claims and/or general auditing experience

Licensure, Certifications, and Clearances:
  • Certified Coding Specialist or Certified Professional Coder or Registered Health Information Administrator or Registered Health Information Technician

UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities

Salary Range: $22.60 to $39.11

Union Position: No

Apply Current Employee?

At UPMC, our shared goal is to create a cohesive, positive, experience for our employees, patients, health plan members, and community. If you too are driven by these values, you may be a great fit at UPMC!

QUALITY & SAFETY
DIGNITY & RESPECT
CARING & LISTENING
RESPONSIBILITY & INTEGRITY
EXCELLENCE & INNOVATION

UPMC provides a total rewards package that can help you achieve the goals you have for your career and your personal life. Whether you want to learn a new skill through a training course, reach personal health and wellness targets, become more involved in your community, or follow a career path that provides you with the right experience to be successful, UPMC can help you get to where you want to be.



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